Question | Answer |
UE flexion synergy pattern | scap elevation ad retraction
shoulder abd and ER
elbow flexion
forearm supination
wris/finger flexion |
LE flexion synergy | hip flexion, abd, ER
Knee flexion
ankle DF/IV
toe DF |
Number of spinal nerves
(how are they divided) | 8 cervical
12 thoraicic
5 lumbar
5 sacral
1 coccygeal |
Sympathetic and Parasympathetic Neurotransmitters | S: Norepinepherine
P: Acetylcholine |
Admoninal Reflex
Level?
Normal | T8-L1
abs contract
deviate belly button in direction of stimulus |
Corneal Blink reflex Normal
nerves | Both eyes blink with stimulus of one
Trigeminal
facial |
Cremasteric reflex normal
nerve level | brisk and brief elevation of testical ipsi to stroke
L1-2 |
Gag reflex nerves | glossopharangeal and vagus |
Plantar reflex nerves & +
normal | L5-S1
Babinski (toes flare)
toes flex |
REFLEX GRADING | 0 no
1+ depressed
2+ normal
3+ exaggerated
4+ hyperactive |
how to test superficial sensation | temperature
light touch
pain |
how to test deep sensaiton | proprioception
kinesthesia
vibration |
How to test corticcal sensation | B simultaneous stimulation
stereognosis
2 pt discrimiantion
barognosis
localization of touch |
what tuning fork Hz should be used | 128Hz |
Monofilament protective sensation | |
Barognosis | wt of differnet objects in hand |
Graphesthesia | identify number of letter drawn on skin |
Kinesthesia | identify direction and extent of movement of a joint or body part |
Localization | identify exact spot being touched |
proprioception | identify statically ehre limb is positoined |
Stereognosis | identify object witout sight in hand |
Superficial Pain | Perceive noxious stimulus using pen cap, paper clip end or pin |
Two point discrimination | identify one or 2 points |
Mono filament loss of protective sensation | 5.07 (10 g) |
Allodynia | sense pain in response to stimulus that would not normally produce pain |
Analgesia | absent of pain while remaining consious |
Anesthesia | absent of touch sensation |
Causalgia | constant reelentless, burning hyperesthesia & hyperalgesia after peripheral nerve injury |
Dysesthesia | disortion of any of senses (especially touch) |
Hyperesthesia | heightened sensation |
Hyperpathia | extreme exaggerated response to pain |
Hypesthesia | diminished sesnation to touch |
Neuralgia | sever and multiple shock like pains that radiate from a specific nerve distribution |
pallanesthesia | loss of vibration sensation |
paresthesia | abdnormal sensation (tingling, pins and needles burning) |
Wallerian Degeneration | degeneration that occurs distally specifically to myelin sheath and axon |
common cause of axillary nerve injury | fx of humerus
ant dislocation of shoulder |
common cuase of musculocutaneous injury | fx of clavicle |
common cause of radial nerve injury | radial tunnel compression
fx of humerus |
common cause of median nerve injury | carpal tunnel
protator teres entrapment |
common cause of ulnar nerve injury | cubital tunnel
entrapment of guyons canal |
common cause of femorla nerve injury | arhtoplasty
displaced acentabular fx
ant dislocation of femure
hysterectomy
appendectomy |
common cause of sciatic N injury | blunt force trauma to buttocks
THA
accidental injection to nerve |
common cause of obturator N injury | fixation of femure fx
THA |
common cause of peroneal N inury | femur, tib, fib Fx
positioning during surgical procedures |
common cause of Tibial N injury | tarsal tunnel entrapment
popliteal fossa compression |
common cause of Sural N injury | calcaneous fx
Laterall malleolus Fx |
Agnosia | inability to recognize familiar objects w one form of sensation |
Akinesia | inability to initiate movement |
Aphasia | disturbance to language that results in errors in word choice, comprehension or syntax |
Expressive or brocas aphasia | sever difficulty in verbal expression
impairment in object naming and writing abilities (R hemi) |
Global aphasia | most sever
reduced speech and comprehension
reading and writting impaired |
Receptive or Wernickes aphasia | sever disturbance in auditory comprehension
impaired reading, writing, word recognition |
Apraxia | inability to perform movements previously learned even though no loss in strength, coordination, sensation or comprehension |
ideational apraxia | doesn't get how to do task |
ideomotor apraxia | can not do task on command but cna do it spontaneously |
Astereogenosis | inability to recognize object by touch |
asynergia | inability to move muscles together in a coordianted manner |
Ataxia | uncoordianted movement
(especially gait) |
Athetosis | slow, involuntary, worm like twisting mtions
(CP) |
What is reflex sympathetic dustrophy now called? | Causalgia |
Cheyne Stokes Respiration | bizaree breathing pattern
periods of apnea 10-60 sec followed by gradually increasing then decreasing depth and frequency of respiration |
Chorea | Rapid involuntary movements |
Clonus | rhythmic oscillations of muscle n response to sustaind stretch in pt w UMN |
Contraction of extensor muscles of UE and LE bc of injury at brain stem | decerebrate rigidity |
Contraction of flexor muscles of UE and contraction of extnesor muscles of LE | Decorticate Rigidity |
Delirium | temporary confusion and loss of mental function |
Dementia | loss of memory or intellectual function |
Dysmetria | inability to judge distance |
virus of shingles | herpes Zoster |
Horners syndrome S&S | P: ptosis (eye lid)
A: agnosia (lack of sweating) ipsi face
M: Myosis (pupil restriction) |
If nerve is damaged how is velocity and latency affected | Velocity slowed
latency increased |
Nystagmus | rapid back and forth movement of eye balls |
Somatagnosia | lack of awareness of relationship of ones own body parts or the body parts of others |
vision alterantion from damage to optic tract | Homonymous Hemianopsia |
Vision alteration from damage to optic chiasma | temporal or peripheral vision fields B |
Vision alteration from ptic nerve damage | monocular blindness |
Tunning for level to test vibration sense? | 128 Hz |
Number determines loss of protective sensation? | 5.07 monofilament |
All of these conditions are stemming from an issue with___?
akinesia
bradykinesia
athetosis
chorea
hemiballismus
rigidity
Dystonia
Tremor | basal ganglai |
Gait speed < 0.4 is for | house |
gait speed 0.4-0.8 is for | limited community ambulatory |
gait speed >0.8 | community ambulatory |
NLI level | most caudal level w motor and sensory |
Zone of partial preservation is only in what types | complete |
Grief stages | Denial
agression
bargin
Depression
acceptance |
neuropraxia def | myelin dysfunction
reversible |
axonotmesis | axon damage regeneration can occur |
neurotmesis | axon, myelin, connective tissue component |
anterior horn conditions | ALS
Poliomyelitis |
Neuromuscular junction conditions | myasthenia gravis |
UMND characteristics and tests | Hyperactive
atrophy
no fascinations
hypertonis
ankle clonus
babinski |
LMND characteristics and tests? | decreased reflexes
atrophy fasiculations
hypotonic --> flaccid |
parasympathetic roots are from? | cervical and lumbar |
Sympathetic roots are from | thoracic |
where is brocas area | frontal lobe |
what does the frontal lobe do? | executive function
voluntary movement
personality
emotions
judgement |
What does the parietal lobe do? | touch/sense
proprioception
pain sensaion
temp |
temporal lobe does? | auditory
interpret emotions and actions |
occipital lob controls | vision
distance/demensions |
white matter characteristics | in brain connects parts myelinated
no dendrites
projection and association fibers |
Graymatter characteristics | unmyelinated neurons |
Basal ganglia neuro diseases? | PD
huntingtons
touretts syndrome
ADD
obsesive compulsie |
limbic system controls | mood
emotion
processing and store memory
olfaction appetite
emotional response to food |
hippocampus is the? | memory indexer
long temr memory |
what does the amygdala do? | emotional processing
fear pleasure
arousal
procesing of memory
formation of emotional memory |
Components of diencephalon? | thalmus
hypothalmus
epithalmus |
What does the thalmus integrate sensory wise? | everything except smell to the cerebra cortex |
What does the thalmus relay for the motor systme? | from cerebellum to precentral motor cortex |
What does the hypothalmus integrate? | regulate hormones and maintain body homeostatis |
What does the Epithalmus integrate? | olfactory (smell)
pineal gland |
What is thalmic pain? | spontaneous pain on contra side of body to leasion |
Hypothalmus is off what issues can arrise? | obesity
sexual disintrest
poor temp control
diabetes insipidus |
What is the midbrain the relay station for. | cerebrum, cerebellum, SC |
What makes up the brain stem? | midbrain
pons
medulla oblongota |
Cerebellum damage creates symptoms on what side? | ipsilateral |
what CN come off of the Pons? | middle 4 |
Pons regulates what? | Respiratrory rate
orient head to vision and auditory |
Medulla ablongotta Cn come off of it? | Last 4 |
medulla oblongotta regualtes? | RR
HO
somatosensation info for organs
arousal and sleep |
What reflexes are regulates by the medulla oblongotta? | Vomit
cough
sneeze |
damage to the medulla oblongotta creates what side impairments? | contralateral |
What part of the SC is gray matter? | Center
anterior, lateral, posterio horns |
What is controlled through the anterior horn? | efferent motor |
What is controlled through the lateral horn? | motor thoracic and upper lubar
ANS Preganglion |
What is regulated through the posterior horn? | afferent sensory |
where are the cell bodies and ganglions in the gray matter of the SC? | posterior horn |
what makes up the ascending white matter tracts of the spinal cord? | Spinothalamic
Spinocerebrall
Dorsal column medial lemniscus |
what is sent through the spinothalamic pathway? | pain
temp
pressure |
lateral spinothalamic orientation of head to toe on SC? | cervical medial
sacral outer/lateral |
| ipsilateral sense of proprioception
tension n muscles
joint sense
posture |
What is sent in the dorsal column medial leminscus? | all the the other sense besides temp, pain, touch/pressure |
Orientation of head to toe with dorsal column medial leminscus? | sacral medial
cervical lateral |
where are the axons in the SC? | white matter |
Where does the spinothalamic pathway cross at? | SC |
Where does the dorsal column medial lemniscal pathway cross at? | meduall oblongata |
The lateral corticospinal ltract pyramid orintation from head to toe? | medial is cervical
latera/outer sacral |
Anterior cortical spinal tract of Pyramidal tracts that are descending control? | ipsilateral voluntary discrete & skilled movement |
lateral cortical spinal tract of Pyramidal tracts that are descending control? | contralateral voluntary fine movements |
Damage to lateral corticospinal tract shows? | + babinski
absent superfical abdominal reflex
+ cremastic reflex
loss of fine motor and skilled voluntayr movement |
Descending extra pyramidal tracts control? | grading of movements
flexor withdrawl rflex |
Damage to extra pyramidal descending tracts casues/ | paralysis
hypertonicity
exaggerated DTR
clasp knife reaction |
Wish stroke recovery are synergies or spasticity seen at the beginning of recovery? | synergy |
Right CVA characteristics | L sided impairments
poor attention
impaired awarenss and judgement
spatial deficits
memory deficits
emotional lability
impulsive |
Left CVA characteristics | Right sided impairments
increased frustration
aphasia
dysphagia
motor apraxia
language impairments |
what aphasia should be treated w simple yes and not pharases? | non fluent
brocas |
what aphasia should eb treated w words and gestures and manual cues? | fluent aphasia |
ACA CVA symptoms? | LE>UE
incontinent
apraxia
bradykinesia
motor inaction |
MCA CVA symptoms? | UE>LE
aphasia
perceptual deficit
HH
sensory ataxia
limb apraxia |
Dominate side MCA CVA Symptoms? | aphasia brocas and wernickes |
Non dominate side MCA CVA symptoms? | percetual: neglect, spadial disorganization |
Major stroke invovles what artery and what symptoms? | internal corotid
ACA and MCA but more MCA |
PCA CVA symptoms of peripheral ? | occipital --> vision |
PCA CVA symptoms of central? | Thalmus--> thaomus pain
subthalmus --> involuntayr movement
midbrain --> webers syndrome |
What is webers syndrome? | ptosis (sagging eye lid)
deviated eye |
Vertebribasilar artery CVA types/locaitons? | superior cerebellar
anterior inferior
Posterior inferior cerebellar Artery (PICA) |
Supeior cerebellar CVA symptoms? | movement
coordination
pain/tmep |
Anterior inferior CVA symptoms? | Horners syndrome
(pstosis, anhydrosis, myosis) PAM |
PICA CVA Symptoms? | wallenberge syndrome
-dysphagia
ipsi face & contra body
ptosis
horseness
pain |
Webers syndrome cause? | Central PCA
central PCA |
Horners syndrome what? cause? | anterior inferior vertebropasialr artery CVA
ptosis, anhydrois, myosis |
Wallenberg syndrome what> cause? | PICA CVA
ipsi face & contra body sensory
ataxia
dysarthria
vomit
nausea
pain |
levels of Rancho Los Amigos TBI scale | I --> X |
what Racnho levles need total assist? | no response
general response
local respose
I --> III |
what Ranch TBI need max assist? | Confused aggitated
confused inapproprite
IV,V |
what rancho level TBI need mod assist? | confused appopriate VI |
what rancho level need min assist | automatic appropriate |
What ranco level needs SBA? | purposeful approriate x2 |
What Rancho level needs mod I? | last purposeful appropiate |
List rancho levels? | no response
general response
local resonse
confused aggitted
confused innapriparite
confused approrpiate
autopatic approriate
puposeful approprite x3 |
What rancho level is it important to focus on structure? | confused inappropriate |
when do past memories more than recent begin to show in rancho level for tbi? | confused approprite |
What TBI rancho level is like a robot? | Automatic appropriate |
what TBI level shows carryover fro new learning but intoleranct to stress? | first purposeful appropriate |
what TBI level should you watch for depression and utilize to do lists? | 2nd purp app |
when can periodic periods of depression be seen and can multi task w breaks w TBI level? | last purp app |
what TB level shoulde you shift between differnet tasks every 2 hours? | 2nd purposeful appropiraite |
list ASIA impairment scale names? | A complete
B sensry incomplete
C motor incomplete
Dmotor incomplete
E normal |
What is the difference between ASIA C & D motor incomplete? | C MMT <3/5
D MMT > 3/5 |
spinal shock resolves in? | 24 hours |
Brown sequard MOI?
S&S | stab/gun --> hemi section
ipsi motor & contra pain & temp |
Anterior cord syndroem MOI & SYS | hyperflexion
motor corticospinal & spinothalamc Pain & tempt |
Central cord Syndrome MOI & S&S/ | hypertextension (stenosis & DJD)
UE Motor and sensory loss
LE varies |
Posterior cord Syndrome MOI? S&S? | compression, tumor, alcohol syndrome
loss dorsal column senses |
Cauda Equinus injury S&S and outcome? | bowel bladder sex
regneration possible due to LMN periph nerve |
intercostal nerve roots? | T1-12 |
abdominal nerve roots? | T5-12 |
Cough above what level will be impaired? | T10 |
Vital capacity impaired at anythign above level of injury at? | T10 |
injury of what level affect bowel and bladder? | S2-4 |
bladder UMN impairment condition? | Reflexive
empty when filled |
Bladder LMN conditions and meaning? | Autonomous/nonreflexive
flaccid bladder and need stimulous to empty |
Autonomic dysreflexia occur aboe what levle?
S&S? | T6
^ BP, bradycaridia, pounding headache, flushing sweating, anxiety |
what SCI level uses glossopharangyeal breathing to cough? what level uses manual assistance? | C4
C5 |
Startingat what SCI level can they cough independnelty and use manual WC at home?? | C6 |
what level can do self LE ROM? | C7 |
what level can live at home alone except for heavy work? | C8 |
What SCI can walk w a walker? | T6-8 |
When are PD pts best do do PT? | morning after meds |
what are the hoehn and Yahr PD stages? | 1: uni involvmenet
2: B involvmeent no balnace issues
3: imapired righting reflex
4: severly disabling (walker)
5: confined to bed or WC |
MS cause? | demyelination |
when are MS pts best for PT | morning |
Relapse remitting MS? | days to moths attac then full or partial recovery |
Secondary progressive MS?
life line? | relapse remitting but progressive 5-10 years |
Primary Progressive MS?
life span | Steady decline from onset
not past 40 |
Progressive relapsing MS? | progressive from onset but clear exacerbations |
Most common MS type? | relapse remitting |
ALS/Lou Gehrigs disease involves what part of NS? | UMN & LMN & CNs |
what has muscel weakness first w ALS? | hands |
What 2 CN are responsible for Pupilary reflex and how? | II: optic sensory brings info in
III: oculomotor constricts pupil N |
CN affected by ALS? | 5,7,9,10,12 |
lie expectancy of ALS? | 2-5 years |
Myesthenia Gravis disease type? | Autoimmune of motor end plates |
What is the first S&S of MG? | eye lids |
Muslce weakness moves in what direction and MG progresses/ | Proximal to distal |
GB is typically caused from____origi to the immune sysem? | viral |
S&S of BG? | symmetrical distalto proximal
LMN & CNs
stocking glove |
Recoveyr from GB can take up to ____w some impairments still. | 1 year |
Bells palsy affects what CN? | VII facial |
what is post polio? | muscular dystrophy decades after initla polio |
Post polio S&S? | Asymmetrical muscle weakness
myalgia
fatigeu
decreased endurance |
Tx of post polio? | orthotics
low intensit
endurane
enercy concervaiton |
Duchennes muscular Dustrophy cause? | genetic affecting males |
Duchennes S&S | 3-7 yo
gowers sign
scoliosis progress afte 11 yo |
Charcot marie tooth disease causes and what is affected? | hereditiaty
peroneal and distal eg (foot drp & stork foot deformitu) |
TX of Charcot marie tooth? | orthotic for equinovarus deformity |
vertigo lastin seconds is normally? | BPPV or TIA |
Vertigo lasting hours is normally? | Meniers or stroke |
Vertigo lasting days is normally? | vestibular neuritis/labyrinthitis
TBI |
H tests what CN? | 3 oculomotor
4 trochlear
6 abducens |
BPPV posterior canal test? Tx? | Dix hallpike
EPly |
BPPV horizontal canal test?TX? | roll test
appiani |
what outcoem measure is good to use w Vertigo? | DGI |
EPly maneuver and lamperts/BBQ ROll which ear is being treated? | the one down or rotated towards |
Dix hallpike test what eye are u testing and what direction will the eye beating go? | one that is down
beats toward affected ear |
Difficulty with smooth pursite and saccad are impairments with what? | CNS |
dificulty w dynamit visual acuity means impairment with? | VOR
vestib occular reflex |
D2 motion? | Sward |
D1 motion? | answering phone |
What is Simian line (palmar crease) seen in? | downs syndrome |
Erbs palsy affects what nerve roots? | C5-6 |
huntingtons MOI?
prognosis/ | degeneration and atrophy of basal ganglai
death 15-20 years |
S&S of huntingtons | mental deterioration
speech disturbances
ataxic gait |
what type of rigidity is seen in parkinsons disease? | lead pipe or cog wheel
cog wheel more common |
Occulta myelomeningocele means? | incomplete fsion of vertebral arch
no neurla tissue protuding |
Meningocele myelomeningocele means? | incomplee fusion w neural tissue sticking out |
Myelomeningocele myelomeningocele means? | incomplete fusion
meninges sticking out
spinal cord sticking out |
when to contact a doctor when a seizure is happening? | time it and greater than 5 min |
Types of seizures and symptoms? | Petite mal: "day dream"
grnad mal: entire body |